Department of Cardiology, Herlev-Gentofte University Hospital, University of Copenhagen, Hellerup, Denmark.
Department of Cardiology, Herlev-Gentofte University Hospital, University of Copenhagen, Hellerup, Denmark; Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark.
Am Heart J. 2022 Feb;244:42-49. doi: 10.1016/j.ahj.2021.10.182. Epub 2021 Oct 16.
Electrical cardioversion (ECV) is a common procedure for terminating atrial fibrillation (AF). ECV is associated with brady-arrhythmic events, however, the age-specific risks of clinically significant brady-arrhythmic events are unknown.
Using Danish nationwide registers, we identified patients with AF at their first non-emergent ECV between 2005 and 2018 and estimated their 30-day risk of brady-arrhythmic events. Moreover, factors associated with increased risks of brady-arrhythmias were identified. Absolute risks were estimated using logistic regression models fitted with natural splines as well as standardization (G-formula).
We identified 20,725 eligible patients with a median age of 66 years (IQR 60-72) and most males (73%). The 30-day risks of brady-arrhythmic events after ECV were highly dependent on age with estimated risks ranging from 0.5% (95% CI 0.2-1.7) and 1.2% (95% CI 0.99-1.5) to 2.7% (95% CI 2.1-3.3) and 5.1% (95% CI 2.6-9.7) in patients aged 40, 65, 80, and 90 years, respectively. Factors associated with brady-arrhythmias were generally related to cardiovascular disease (eg, ischemic heart disease, heart failure, valvular AF) or a history of syncope. We found no indications that pre-treatment with anti-arrhythmic drugs conferred increased risks of brady-arrhythmic events (standardized absolute risk difference -0.25% [95% CI -0.67 to 0.17]).
ECV conferred clinically relevant 30-day risks of brady-arrhythmic events, especially in older patients. Anti-arrhythmic drug treatment was not found to increase the risk of brady-arrhythmias. Given the widespread use of ECV, these data should provide insights regarding the potential risks of brady-arrhythmic events.
电复律（ECV）是终止心房颤动（AF）的常见程序。ECV 与缓慢性心律失常事件相关，然而，特定年龄的临床显著缓慢性心律失常事件的风险尚不清楚。
使用丹麦全国登记处，我们确定了 2005 年至 2018 年间首次非紧急 ECV 时患有 AF 的患者，并估计了他们 30 天缓慢性心律失常事件的风险。此外，还确定了与缓慢性心律失常风险增加相关的因素。使用逻辑回归模型和自然样条拟合以及标准化（G 公式）来估计绝对风险。
我们确定了 20725 名符合条件的患者，中位年龄为 66 岁（IQR 60-72），大多数为男性（73%）。ECV 后缓慢性心律失常事件的 30 天风险高度依赖于年龄，估计风险范围从 0.5%（95%CI 0.2-1.7）和 1.2%（95%CI 0.99-1.5）到 2.7%（95%CI 2.1-3.3）和 5.1%（95%CI 2.6-9.7）在年龄分别为 40、65、80 和 90 岁的患者中。与缓慢性心律失常相关的因素通常与心血管疾病（例如，缺血性心脏病、心力衰竭、瓣膜性 AF）或晕厥史有关。我们没有发现提示抗心律失常药物预处理会增加缓慢性心律失常事件的风险（标准化绝对风险差异-0.25%[95%CI-0.67 至 0.17]）。
ECV 导致了临床上相关的 30 天缓慢性心律失常事件的风险，特别是在老年患者中。抗心律失常药物治疗并未发现增加缓慢性心律失常的风险。鉴于 ECV 的广泛应用，这些数据应该提供关于缓慢性心律失常事件潜在风险的见解。
